Sexually transmitted infection

For other uses, see the Old Testament.[7] There is often shame and stigma associated with these infections.[1] The term sexually transmitted infection is generally preferred over the terms sexuit includes
Sexually transmitted infections (STI), also referred ally transmitted disease and venereal disease, as
those who do not have symptomatic disease.[8]
to as sexually transmitted diseases (STD) and venereal diseases (VD), are infections that are commonly
spread by sex, especially vaginal intercourse, anal sex and
oral sex. Most STIs initially do not cause symptoms.[1] 1 Classication
This results in a greater risk of passing the disease on
to others.[2] Symptoms and signs of disease may include
vaginal discharge, penile discharge, ulcers on or around
the genitals, and pelvic pain. STIs acquired before or
during birth may result in poor outcomes for the baby.
Some STIs may cause problems with the ability to get
pregnant.[1]
Sexual disease redirects here.
Sexual dysfunction.

More than 30 dierent bacteria, viruses, and parasites

can cause STIs.[1] Bacterial STIs include chlamydia,
gonorrhea, and syphilis among others. Viral STIs include
genital herpes, HIV/AIDS, and genital warts among others. Parasitic STIs include trichomoniasis among others.
While usually spread by sex, some STIs can also be spread
by non-sexual contact with contaminated blood and tissues, breastfeeding, or during childbirth.[1] STI diagnostic tests are easily available in the developed world, but
this is often not the case in the developing world.[1]
The most eective way of preventing STIs is by not having sex.[3] Some vaccinations may also decrease the risk
of certain infections including hepatitis B and some types
of HPV.[3] Safer sex practices such as use of condoms,
having a smaller number of sexual partners, and being in
a relationship where each person only has sex with the
other also decreases the risk.[1][3] Circumcision in males
may be eective to prevent some infections.[1] Most STIs
are treatable or curable.[1] Of the most common infections, syphilis, gonorrhea, chlamydia, trichomoniasis are
curable, while herpes, hepatitis B, HIV/AIDS, and HPV
are treatable but not curable.[1] Resistance to certain
antibiotics is developing among some organisms such as
gonorrhea.[4]

A poster from the Oce for Emergency Management. Oce of

War Information, 1941-1945

Until the 1990s, STIs were commonly known as venereal diseases, the word venereal being derived from the
Latin word venereus, and meaning relating to sexual intercourse or desire, ultimately derived from Venus, the
In 2008, it was estimated that 500 million people were
Roman goddess of love.[9] Social disease was a phrase
infected with either syphilis, gonorrhea, chlamydia or
used as a euphemism.
trichomoniasis.[1] At least an additional 530 million people have genital herpes and 290 million women have The World Health Organization (WHO) has recomhuman papillomavirus.[1] STIs other than HIV resulted mended sexually transmitted infection as the preferred
[8]
in 142,000 deaths in 2013.[5] In the United States there term since 1999. Sexually transmitted infection is a
[10]
An
were 19 million new cases of sexually transmitted infec- broader term than sexually transmitted disease.
[6]
tions in 2010. Historical documentation of STIs date infection is a colonization by a parasitic species, which
back to at least the Ebers papyrus around 1550 BC and may not cause any adverse eects. In a disease, the infection leads to impaired or abnormal function. In either
1

3 CAUSE

case, the condition may not exhibit signs or symptoms.

Granuloma inguinale or (Klebsiella granulomatis)
Increased understanding of infections like HPV, which
Mycoplasma genitalium[26]
infects a signicant portion of sexually active individuals but cause disease in only a few, has led to increased
Syphilis (Treponema pallidum)
use of the term STI. Public health ocials originally introduced the term sexually transmitted infection, which
clinicians are increasingly using alongside the term sex- 3.3 Fungal
ually transmitted disease in order to distinguish it from
Candidiasis (yeast infection)
the former.[11]
STD may refer only to infections that are causing diseases,
or it may be used more loosely as a synonym for STI. Most 3.4 Viral
of the time, people do not know that they are infected
with an STI until they are tested or start showing symptoms of disease. Moreover, the term sexually transmissible disease is sometimes used since it is less restrictive in
consideration of other factors or means of transmission.
For instance, meningitis is transmissible by means of sexual contact but is not labeled an STI because sexual contact is not the primary vector for the pathogens that cause
meningitis. This discrepancy is addressed by the probability of infection by means other than sexual contact. In
general, an STI is an infection that has a negligible probability of transmission by means other than sexual contact,
but has a realistic means of transmission by sexual contact (more sophisticated meansblood transfusion, sharing of hypodermic needlesare not taken into account).
Thus, one may presume that, if a person is infected with
an STI, e.g., chlamydia, gonorrhea, genital herpes, HPV Micrograph showing the viral cytopathic eect of herpes (ground
glass nuclear inclusions, multi-nucleation). Pap test. Pap stain.
it was transmitted to him/her by means of sexual contact.

Signs and symptoms

Not all STIs are symptomatic, and symptoms may not

appear immediately after infection. In some instances a
disease can be carried with no symptoms, which leaves
a greater risk of passing the disease on to others. Depending on the disease, some untreated STIs can lead to
infertility, chronic pain or even death.[12]

Cause

3.1

Transmission

The risks and transmission probabilities of sexually

transmitted diseases are summarized by act in the
table:[13][14][15][16][17][18][19][20][21][22][23][24][25]

3.2

Bacterial

Chancroid (Haemophilus ducreyi)

Chlamydia (Chlamydia trachomatis)
Gonorrhea (Neisseria gonorrhoeae), colloquially
known as the clap

Viral hepatitis (Hepatitis B virus)saliva, venereal

uids.
(Note: Hepatitis A and Hepatitis E are transmitted
via the fecal-oral route; Hepatitis C is rarely sexually transmittable,[27] and the route of transmission
of Hepatitis D (only if infected with B) is uncertain,
but may include sexual transmission.[28][29][30] )
Herpes simplex (Herpes simplex virus 1, 2) skin and
mucosal, transmissible with or without visible blisters
HIV (Human Immunodeciency Virus)venereal
uids, semen, breast milk, blood
HPV (Human Papillomavirus)skin and mucosal
contact. 'High risk' types of HPV cause almost all
cervical cancers, as well as some anal, penile, and
vulvar cancer. Some other types of HPV cause
genital warts.
Molluscum contagiosum (molluscum contagiosum
virus MCV)close contact

3.5 Parasites
Crab louse, colloquially known as crabs or pubic
lice (Pthirus pubis)
Scabies (Sarcoptes scabiei)

3.7

3.6

Main types

Protozoal

Trichomoniasis (Trichomonas vaginalis), colloquially known as trich

3.7

Main types

Sexually transmitted infections include:

Chlamydia is a sexually transmitted infection caused
by the bacterium Chlamydia trachomatis.
In
women, symptoms may include abnormal vaginal
discharge, burning during urination, and bleeding in
between periods, although most women do not experience any symptoms.[31] Symptoms in men include pain when urinating, and abnormal discharge
from their penis.[32] If left untreated in both men
and women, Chlamydia can infect the urinary tract
and potentially lead to pelvic inammatory disease
(PID). PID can cause serious problems during pregnancy and even has the potential to cause infertility.
It can cause a woman to have a potentially deadly ectopic pregnancy, in which the child is born outside of
the uterus. However, Chlamydia can be cured with
antibiotics.
The two most common forms of herpes are caused
by infection with herpes simplex virus (HSV). HSV1 is typically acquired orally and causes cold sores,
HSV-2 is usually acquired during sexual contact and
aects the genitals, however either strain may affect either site.[33] Some people are asymptomatic
or have very mild symptoms. Those that do experience symptoms usually notice them 2 to 20 days after exposure which last 2 to 4 weeks. Symptoms can
include small uid-lled blisters, headaches, backaches, itching or tingling sensations in the genital or
anal area, pain during urination, Flu like symptoms,
swollen glands, or fever. Herpes is spread through
skin contact with a person infected with the virus.
The virus aects the areas where it entered the body.
This can occur through kissing, vaginal intercourse,
oral sex or anal sex. The virus is most infectious
during times when there are visible symptoms, however those who are asymptomatic can still spread the
virus through skin contact.[34] The primary attack is
the most severe because the body does not have any
antibodies built up. After the primary attack, one
might have recurring attacks that are milder or might
not even have future attacks. There is no cure for
the disease but there are antiviral medications that
treat its symptoms and lower the risk of transmission
(Valtrex). Although HSV-1 is typically the oral
version of the virus, and HSV-2 is typically the genital version of the virus, a person with HSV-1 orally
CAN transmit that virus to their partner genitally.
The virus, either type, will settle into a nerve bundle

3
either at the top of the spine, producing the oral
outbreak, or a second nerve bundle at the base of
the spine, producing the genital outbreak.
The human papillomavirus (HPV) is the most common STI in the United States.[35] There are more
than 40 dierent strands of HPV and many do not
cause any health problems. In 90% of cases the
bodys immune system clears the infection naturally
within 2 years.[36] Some cases may not be cleared
and can lead to genital warts (bumps around the
genitals that can be small or large, raised or at, or
shaped like cauliower) or cervical cancer and other
HPV related cancers. Symptoms might not show up
until advanced stages. It is important for women
to get pap smears in order to check for and treat
cancers. There are also two vaccines available for
women (Cervarix and Gardasil) that protect against
the types of HPV that cause cervical cancer. HPV
can be passed through genital-to-genital contact as
well as during oral sex. It is important to remember
that the infected partner might not have any symptoms.
Gonorrhea is caused by bacterium that lives on moist
mucous membranes in the urethra, vagina, rectum,
mouth, throat, and eyes. The infection can spread
through contact with the penis, vagina, mouth or
anus. Symptoms of Gonorrhea usually appear 2 to
5 days after contact with an infected partner however, some men might not notice symptoms for up
to a month. Symptoms in men include burning and
pain while urinating, increased urinary frequency,
discharge from the penis (white, green, or yellow
in color), red or swollen urethra, swollen or tender testicles, or sore throat. Symptoms in women
may include vaginal discharge, burning or itching
while urinating, painful sexual intercourse, severe
pain in lower abdomen (if infection spreads to fallopian tubes), or fever (if infection spreads to fallopian tubes), however many women do not show
any symptoms.[37] There are some antibiotic resistant strains for Gonorrhea but most cases can be
cured with antibiotics.

Syphilis is an STI caused by a bacterium. Untreated,

it can lead to complications and death.[38] Clinical
manifestations of syphilis include the ulceration of
the uro-genital tract, mouth or rectum; if left untreated the symptoms worsen. In recent years, the
prevalence of syphilis has declined in Western Europe, but it has increased in Eastern Europe (former Soviet states). A high incidence of syphilis can
be found in places such as Cameroon, Cambodia,
Papua New Guinea.[39] Syphilis infections are increasing in the United States.[40]

4 PATHOPHYSIOLOGY

3.8 Unscreened
There are many species of bacteria, protozoa, fungi, and
viruses, many which remain undocumented or poorly
studied with regards to sexual transmission. Despite that
the above include what are generally known as STIs, sexually transmission of microbes is far from limited to the
above list. Since the sexual route of transmission is not
considered common, and/or the microbe itself is not implicated in a major research study on disease, the following pathogens are simply not screened for in sexual health
clinics. Some of these microbes are known to be sexually
transmittable.
Secondary syphilis

Trichomoniasis is a common STI that is caused

by infection with a protozoan parasite called Trichomonas vaginalis.[41] Trichomoniasis aects both
women and men, but symptoms are more common in women.[42] Most patients are treated with
an antibiotic called metronidazole, which is very
eective.[43]
HIV (human immunodeciency virus) damages the
bodys immune system, which interferes with its
ability to ght o disease-causing agents. The virus
kills CD4 cells, which are white blood cells that
help ght o various infections. HIV is carried
in body uids, and is spread by sexual activity. It
can also be spread by contact with infected blood,
breast feeding, childbirth, and from mother to child
during pregnancy.[44] When HIV is at its most advanced stage, an individual is said to have AIDS
(acquired immunodeciency syndrome).[45] There
are dierent stages of the progression of and HIV
infection. The stages include primary infection,
asymptomatic infection, symptomatic infection, and
AIDS. In the primary infection stage, an individual will have u like symptoms (headache, fatigue,
fever, muscle aches) for about 2 weeks. In the
asymptomatic stage, symptoms usually disappear,
and the patient can remain asymptomatic for years.
When HIV progresses to the symptomatic stage, the
immune system is weakened, and has a low cell
count of CD4+ T Cells. When the HIV infection
becomes life-threatening, it is called AIDS. People
with AIDS fall prey to opportunistic infections and
die as a result.[31] When the disease was rst discovered in the 1980s, those who had AIDS were not
likely to live longer than a few years. There are now
antiretroviral drugs (ARVs) available to treat HIV
infections. There is no known cure for HIV or AIDS
but the drugs help suppress the virus. By suppressing the amount of virus in the body, people can lead
longer and healthier lives. Even though their virus
levels may be low they can still spread the virus to
others.[46]

Microbes known to be sexually transmissible (but not

generally considered STDs/STIs) include:
Ebola- transmissible 2 months after recovery.[1]
cases of tranmission as long as 5 months.[47]
Marburg virus - Virus in semen for 7 weeks after
clinical recovery.[48]
HTLV (both types 1 and 2) - Sexually transmissible,
consumption of breast milk breastfeeding, and once
mistaken as a HIV, risk of leukemia.[49]
Mycoplasma genitalium, which causes urethritis,
urinary tract infections and cervicitis, and cancer.[50]

4 Pathophysiology
Many STIs are (more easily) transmitted through the
mucous membranes of the penis, vulva, rectum, urinary
tract and (less oftendepending on type of infection) the
mouth, throat, respiratory tract and eyes.[51] The visible
membrane covering the head of the penis is a mucous
membrane, though it produces no mucus (similar to the
lips of the mouth). Mucous membranes dier from skin
in that they allow certain pathogens into the body.[52] The
amount of contact with infective sources which causes infection varies with each pathogen but in all cases a disease
may result from even light contact from uid carriers like
venereal uids onto a mucous membrane.
This is one reason that the probability of transmitting
many infections is far higher from sex than by more casual means of transmission, such as non-sexual contact
touching, hugging, shaking handsbut it is not the only
reason. Although mucous membranes exist in the mouth
as in the genitals, many STIs seem to be easier to transmit
through oral sex than through deep kissing. According to
a safe sex chart, many infections that are easily transmitted from the mouth to the genitals or from the genitals to
the mouth are much harder to transmit from one mouth
to another.[53] With HIV, genital uids happen to contain
much more of the pathogen than saliva. Some infections
labeled as STIs can be transmitted by direct skin contact.
Herpes simplex and HPV are both examples. KSHV, on

5
the other hand, may be transmitted by deep-kissing but pelvic inammatory disease.
also when saliva is used as a sexual lubricant.
Depending on the STI, a person may still be able to spread
the infection if no signs of disease are present. For example, a person is much more likely to spread herpes infection when blisters are present than when they are absent.
However, a person can spread HIV infection at any time,
even if he/she has not developed symptoms of AIDS.

5 Prevention

All sexual behaviors that involve contact with the bodily uids of another person should be considered to contain some risk of transmission of sexually transmitted diseases. Most attention has focused on controlling HIV,
which causes AIDS, but each STI presents a dierent situation.
As may be noted from the name, sexually transmitted
diseases are transmitted from one person to another by
certain sexual activities rather than being actually caused
by those sexual activities. Bacteria, fungi, protozoa or
viruses are still the causative agents. It is not possible
to catch any sexually transmitted disease from a sexual
activity with a person who is not carrying a disease; conversely, a person who has an STI got it from contact (sexual or otherwise) with someone who had it, or his/her
bodily uids. Some STIs such as HIV can be transmitted
from mother to child either during pregnancy or breastfeeding.
Although the likelihood of transmitting various diseases
by various sexual activities varies a great deal, in general,
all sexual activities between two (or more) people should San Francisco City Clinic a municipal STI testing center in San
be considered as being a two-way route for the transmis- Francisco.
sion of STIs, i.e., giving or receiving are both risky
although receiving carries a higher risk.
Main article: Safe sex
Healthcare professionals suggest safer sex, such as the use
of condoms, as the most reliable way of decreasing the Prevention is key in addressing incurable STIs, such as
risk of contracting sexually transmitted diseases during HIV and herpes. Sexual health clinics promote the use of
sexual activity, but safer sex should by no means be con- condoms and provide outreach for at-risk communities.
sidered an absolute safeguard. The transfer of and exposure to bodily uids, such as blood transfusions and other The most eective way to prevent sexual transmission of
blood products, sharing injection needles, needle-stick STIs is to avoid contact of body parts or uids which
injuries (when medical sta are inadvertently jabbed or can lead to transfer with an infected partner. Not all
pricked with needles during medical procedures), sharing sexual activities involve contact: cybersex, phonesex or
tattoo needles, and childbirth are other avenues of trans- masturbation from a distance are methods of avoiding
mission. These dierent means put certain groups, such contact. Proper use of condoms reduces contact and
as medical workers, and haemophiliacs and drug users, risk. Although a condom is eective in limiting exposure, some disease transmission may occur even with a
particularly at risk.
condom.[54]
Recent epidemiological studies have investigated the networks that are dened by sexual relationships between Both partners should get tested for STIs before initiatindividuals, and discovered that the properties of sexual ing sexual contact, or before resuming contact if a partnetworks are crucial to the spread of sexually transmitted ner engaged in contact with someone else. Many infecdiseases. In particular, assortative mixing between peo- tions are not detectable immediately after exposure, so
ple with large numbers of sexual partners seems to be an enough time must be allowed between possible exposures
and testing for the tests to be accurate. Certain STIs, parimportant factor.
ticularly certain persistent viruses like HPV, may be imIt is possible to be an asymptomatic carrier of sexually possible to detect with current medical procedures.
transmitted diseases. In particular, sexually transmitted
diseases in women often cause the serious condition of Many diseases that establish permanent infections can so
occupy the immune system that other diseases become

7 DIAGNOSIS

more easily transmitted. The innate immune system led

Using avored condoms for oral sex only, as the
by defensins against HIV can prevent transmission of HIV
sugar in the avoring can lead to yeast infections if
when viral counts are very low, but if busy with other
used to penetrate.
viruses or overwhelmed, HIV can establish itself. Certain
viral STIs also greatly increase the risk of death for HIV In order to best protect oneself and the partner from STIs,
infected patients.
the old condom and its contents should be assumed to be
infectious. Therefore the old condom must be properly
disposed of. A new condom should be used for each act
5.1 Vaccines
of intercourse, as multiple usage increases the chance of
Vaccines are available that protect against some viral breakage, defeating the eectiveness as a barrier.
STIs, such as Hepatitis A, Hepatitis B, and some types
of HPV. Vaccination before initiation of sexual contact
5.3
is advised to assure maximal protection.

Nonoxynol-9

Researchers had hoped that nonoxynol-9, a vaginal microbicide would help decrease STI risk. Trials, however,
have found it ineective[55] and it may put women at a
Condoms and female condoms only provide protection higher risk of HIV infection.[56]
when used properly as a barrier, and only to and from the
area that it covers. Uncovered areas are still susceptible
to many STIs.
6 Screening

5.2

Condoms

In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin; therefore, properly shielding the penis with
a properly worn condom from the vagina or anus eectively stops HIV transmission. An infected uid to broken
skin borne direct transmission of HIV would not be considered sexually transmitted, but can still theoretically
occur during sexual contact. This can be avoided simply
by not engaging in sexual contact when presenting open,
bleeding wounds.

Sexually active women under the age of 25 and those

over 25 with risk should be screened for chlamydia and
gonorrhea yearly.[57] After being treated for gonorrhea
all people should be re tested for the disease after three
months.[57]

Nucleic acid amplication tests are the recommended

method of diagnosis for gonorrhea and chlamydia.[58]
This can be done on either urine in both men and women,
vaginal or cervical swabs in women, or urethral swabs in
Other STIs, even viral infections, can be prevented with men.[58]
the use of latex, polyurethane or polyisoprene condoms
as a barrier. Some microorganisms and viruses are small
enough to pass through the pores in natural skin condoms,
but are still too large to pass through latex or synthetic 7 Diagnosis
condoms.
Testing may be for a single infection, or consist of a numProper male condom usage entails:
ber of tests for a range of STIs, including tests for syphilis,
trichomonas, gonorrhea, chlamydia, herpes, hepatitis and
Not putting the condom on too tight at the end,
HIV. No procedure tests for all infectious agents.
and leaving 1.5 cm (3/4 inch) room at the tip for
ejaculation. Putting the condom on snug can and of- STI tests may be used for a number of reasons:
ten does lead to failure.
Wearing a condom too loose can defeat the barrier.
Avoiding inverting or spilling a condom once worn,
whether it has ejaculate in it or not.
If a user attempts to unroll the condom, but realizes they have it on the wrong side, then this condom
should be discarded.
Being careful with the condom if handling it with
long nails.
Avoiding the use of oil-based lubricants (or anything
with oil in it) with latex condoms, as oil can eat holes
into them.

as a diagnostic test to determine the cause of symptoms or illness

as a screening test to detect asymptomatic or
presymptomatic infections
as a check that prospective sexual partners are free
of disease before they engage in sex without safer
sex precautions (for example, when starting a long
term mutually monogamous sexual relationship, in
uid bonding, or for procreation).
as a check prior to or during pregnancy, to prevent
harm to the baby

7
delivered partner therapy, which is the clinical practice of
treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her
partner without the health care provider rst examining
the partner.[60]

9 Epidemiology

Age-standardized, disability-adjusted life years for STDs

(excluding HIV) per 100,000 inhabitants in 2004.[61]
World War II US Army poster warning of venereal disease

STD incidence rates remain high in most of the world, de as a check after birth, to check that the baby has not spite diagnostic and therapeutic advances that can rapidly
caught an STI from the mother
render patients with many STDs noninfectious and cure
most. In many cultures, changing sexual morals and
to prevent the use of infected donated blood or
oral contraceptive use have eliminated traditional sexorgans
ual restraints, especially for women, and both physicians
as part of the process of contact tracing from a and patients have diculty dealing openly and candidly
with sexual issues. Additionally, development and spread
known infected individual
of drug-resistant bacteria (e.g., penicillin-resistant gono as part of mass epidemiological surveillance
cocci) makes some STDs harder to cure. The eect of
travel is most dramatically illustrated by the rapid spread
Early identication and treatment results in less chance of the AIDS virus (HIV-1) from Africa to Europe and the
to spread disease, and for some conditions may improve Americas in the late 1970s.[62]
the outcomes of treatment. There is often a window peCommonly reported prevalences of STIs among sexually
riod after initial infection during which an STI test will be
active adolescent girls both with and without lower genital
negative. During this period, the infection may be transtract symptoms include chlamydia (1025%), gonorrhea
missible. The duration of this period varies depending on
(318%), syphilis (03%), Trichomonas vaginalis (8
the infection and the test. Diagnosis may also be delayed
16%), and herpes simplex virus (212%). Among adoby reluctance of the infected person to seek a medical
lescent boys with no symptoms of urethritis, isolation
professional. One report indicated that people turn to the
rates include chlamydia (911%) and gonorrhea (23%).
Internet rather than to a medical professional for inforA 2008 CDC study found that 2540% of U.S. teenage
mation on STIs to a higher degree than for other sexual
girls has a sexually transmitted disease.[63][64]
[59]
problems.
AIDS is among the leading causes of death in presentday Sub-Saharan Africa.[65] HIV/AIDS is transmitted
primarily via unprotected sexual intercourse. More
8 Management
than 1.1 million persons are living with HIV/AIDS in
the United States,[66] and it disproportionately impacts
High-risk exposure such as that which occurs in African Americans.[67] Hepatitis B is also considered a
rape cases may be treated preventatively using antibi- sexually transmitted disease because it can be spread
otic combinations such as azithromycin, cexime, and through sexual contact.[68] The highest rates are found in
metronidazole.
Asia and Africa and lower rates are in the Americas and
An option for treating partners of patients (index cases) Europe.[69] Approximately two billion people worldwide
diagnosed with chlamydia or gonorrhea is patient- have been infected with the hepatitis B virus.[70]

10

10 HISTORY

History

U.S. propaganda poster targeted at World War II servicemen appealed to their patriotism in urging them to protect themselves.
The text at the bottom of the poster reads, You can't beat the
Axis if you get VD.
1930s Works Progress Administration poster

The rst well-recorded European outbreak of what is now

known as syphilis occurred in 1494 when it broke out
among French troops besieging Naples in the Italian War
of 149498.[71] The disease may have originated from the
Columbian Exchange.[72] From Naples, the disease swept
across Europe, killing more than ve million people.[73]
As Jared Diamond describes it, "[W]hen syphilis was rst
denitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused
esh to fall from peoples faces, and led to death within a
few months, rendering it far more fatal than it is today.
Diamond concludes,"[B]y 1546, the disease had evolved
into the disease with the symptoms so well known to us
today.[74]
Prior to the invention of modern medicines, sexually
transmitted diseases were generally incurable, and treatment was limited to treating the symptoms of the disease. The rst voluntary hospital for venereal diseases
was founded in 1746 at London Lock Hospital.[75] Treatment was not always voluntary: in the second half of the
19th century, the Contagious Diseases Acts were used to
arrest suspected prostitutes. In 1924, a number of states
concluded the Brussels Agreement, whereby states agreed
to provide free or low-cost medical treatment at ports for
merchant seamen with venereal diseases.

The rst eective treatment for a sexually transmitted

disease was salvarsan, a treatment for syphilis. With
the discovery of antibiotics, a large number of sexually transmitted diseases became easily curable, and this,
combined with eective public health campaigns against
STDs, led to a public perception during the 1960s and
1970s that they have ceased to be a serious medical threat.
During this period, the importance of contact tracing in
treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection,
treating the infected and tracing their contacts in turn, STI
clinics could eectively suppress infections in the general
population.
In the 1980s, rst genital herpes and then AIDS emerged
into the public consciousness as sexually transmitted diseases that could not be cured by modern medicine. AIDS
in particular has a long asymptomatic periodduring
which time HIV (the human immunodeciency virus,
which causes AIDS) can replicate and the disease can
be transmitted to othersfollowed by a symptomatic
period, which leads rapidly to death unless treated.
HIV/AIDS entered the United States from Haiti in
about 1969.[76] Recognition that AIDS threatened a
global pandemic led to public information campaigns
and the development of treatments that allow AIDS to

9
be managed by suppressing the replication of HIV for [14] Maura Gillisons (2007). HPV Infection Linked to Throat
Cancers. Johns Hopkins Medicine.
as long as possible. Contact tracing continues to be an
important measure, even when diseases are incurable, as
[15] Hoare A (2010). models of HIV epidemics in Australia
it helps to contain infection.
and Southeast Asia

[16] Australasian contact tracing manual. Specic infections

where contact tracing is generally recommended

11

References

[1] Sexually transmitted infections (STIs) Fact sheet

N110. who.int. November 2013. Retrieved 30
November 2014.
[2] Patrick R. Murray, Ken S. Rosenthal, Michael A. Pfaller,
(2013). Medical microbiology (7th ed. ed.). St. Louis,
Mo.: Mosby. p. 418. ISBN 9780323086929.
[3] How You Can Prevent Sexually Transmitted Diseases.
cdc.gov. November 5, 2013. Retrieved 5 December 2014.
[4] Centers for Disease Control and Prevention, (CDC) (10
August 2012). Update to CDCs Sexually transmitted
diseases treatment guidelines, 2010: oral cephalosporins
no longer a recommended treatment for gonococcal infections.. MMWR. Morbidity and mortality weekly report 61
(31): 5904. PMID 22874837.
[5] GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). Global, regional, and national
age-sex specic all-cause and cause-specic mortality for
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12

Further reading

Workowski, KA; Berman, S; Centers for Disease Control and Prevention, (CDC) (17 December 2010). Sexually transmitted diseases treatment
guidelines, 2010.. MMWR. Recommendations and
reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 59 (RR-12): 1110. PMID 21160459.
Aral, Sevgi O (2008). Behavioral Interventions for
Prevention and Control of Sexually Transmitted Diseases. : Springer Singapore Pte. Limited. ISBN
978-0-387-85768-8
Faro, Sebastian (2003). Sexually transmitted diseases in women. Lippincott Williams & Wilkins.
ISBN 0-397-51303-8
Ford, Carol A; Elizabeth Shimer Bowers (2009).
Living with Sexually Transmitted Diseases. Facts On
File. ISBN 978-0-8160-7672-7

STDs In Color: Sexually Transmitted Disease Facts

and Photos
: Sexually transmitted diseases in the U.S.

12

14

14
14.1

TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

Text and image sources, contributors, and licenses

Text

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14.2

Images

13

ger65432, Apertus, The Intelligent One, Numbo3-bot, 2cool520, Tide rolls, Sal2k891, XfreddytanX, Xenobot, Jarble, Micki, Matt.T,
Clay Juicer, Luckas-bot, Yobot, Donfbreed, Grakk, Cannywhakawoo, Gotswagg, AnakngAraw, IW.HG, Eric-Wester, Synchronism,
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Shawnecooke, Birkjr, Black-lolgull, LMAO246, Sionus, Capricorn42, The Magnicent Clean-keeper, Renaissancee, Gilo1969, Oncedarkness, ' rtnjkk(), Amore Mio, Mrjjeezy, Nick gregson, Jacobforce, Willsmore, Tyrol5, Omarodarte, NickMETALguitar, GentryRotaro,
Pooshie79, Lovemun06, RibotBOT, Kyng, Buttchin1658, Trielictic, GhalyBot, Moxy, Ajax151, Shadowjams, DasallmchtigeJ, Tobby72, Flybeta, Citation bot 1, FILWISE, RedBot, EfAston, , Lotje, Seahorseruler, Diannaa, Brian the Editor, Tbhotch,
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14.2

Images

File:"VD_CAN_BE_CURED_BUT_THERE'S_NO_MEDICINE_FOR_REGRET"_-_NARA_-_515957.jpg
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svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ea/UserIconMail.svg/48px-UserIconMail.svg.png 2x' data-lewidth='700' data-le-height='700' />I would appreciate being notied if you use my work outside Wikimedia.
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